Pharmacies, chemists and their role
order to prevent or reduce harm to patients and to improve public
health, mechanisms for evaluating and monitoring the safety of medicines
in clinical use are vital. Equally qualified pharmacists are expected to
be professional in their duty, with the knowledge and expertise to
provide authoritative information to medicines.
In Sri Lanka, law specifically warrants ‘Pharmacists’ to hold a
professional certificate. Despite such laws, what is taking place is
many qualified registered pharmacists while displaying their licence
overtly employ ‘unqualified cashiers’ to dispense medicine to the
Press reports recently indicated that the Cosmetic Devices and Drugs
Control Authority, out of a glut of complaints from the public against
pharmacies, raided countrywide and heavy fines were imposed on those who
violated relevant regulations.
During such sorties the common cause for private pharmacies to thrive
on illegal activities has been a case of hiring ‘ordinary’ unqualified
staff as cashiers’ to sell drugs by displaying official ‘Pharmacy’
signs. The major impediment for such abuses of health regulations is
believed to be the inadequacy of ‘special Health Ministry Inspectors’ to
monitor and raid pharmacies regularly and not having an effective
disappointing factor in Sri Lanka today is that anyone wearing a white
overall can act as a pharmacist behind a counter and hand out anything
to the public, even without a prescription.
It is mandatory to give clear details of the drug and potency on the
receptacle when pharmacists hand over drugs to the public. In Sri Lanka
such norms seem to override international procedures and place drugs
into small envelopes (with only tds or bd information). Unorthodox
procedures not only leave patients in naivety but pose a problem if the
patient decides to consult a different medical officer with unidentified
drugs. In Western countries the General (family) Practitioner maintains
all records; whenever a patient is referred to a specialist or a
hospital there is always interaction with the patients’ regular GP.
UK uses ‘GP computer software’ programmes where patients’ history is
stored. When the GP decides on the medication he simply types out the
name of the drug(s) to be prescribed and a computer printout throws out
the drug and its potency with a counterfoil to the patient. Such
advanced systems help both the patient and the GP, especially when it
comes to ‘repeat-prescriptions’. Contrary to such sophisticated methods,
ordinary piece of paper is used in Sri Lanka to write-down a
prescription by some with only the doctor’s name or signature, which is
accepted by some pharmacies.
Recently, in a private hospital I witnessed how a patient was given
four types of drugs from its pharmacy in four small white envelopes. The
patient’s request to a female (inside the Pharmacy who did not wear any
identification tag to indicate she was the chemist) to write-down the
names of the drugs on each envelope was responded with a haughty rebuff
stating: “It’s all written on the drugs”.
My personal inspection of the drugs revealed only Lasarten Potassium
(Cosart 50 ml) and the Omeprazole were the only drugs in a sealed pack
from manufactures. The other envelopes contained Statins for Cholesterol
and some pills without any brand name or potency which the patient was
expected to swallow blindly!
The difference between the West and Sri Lanka is that in the West a
patient has a right to open his/her mouth and say he/she is entitled to
know what patients are asked to swallow”! The medical officer on the
other hand will explain to his/her patient in detail about the
prescribed drugs. But to put up with nonsensical statements as indicated
above from half backed so called ‘pharmacists’ scattered round the
island would be annoying. After all, it’s the patient body, life and
his/her money that one has to bear in mind.
There does not seem to have a uniform law in Sri Lanka or it is not
strictly implemented with regard to the issuance of drugs with or
without a prescription. Recently a friend known to me had to go through
a maze to find out about a cancer drug, Arimdex (1mg).
Despite the huge price difference in two major pharmaceutical
institutions in Sri Lanka the irony is why the lives of cancer patients
have been made much harder and added more pain and misery to their
desolation by making such an important drug a rare commodity and
exorbitant prices! How many cancer patients among low-income groups can
afford to buy such a drug? Are we, as a society, prepared to consign
such patients into a death row labeling them as terminal patients with
no hope at all?
Cancer sufferers are evidently on the increase and this is an area
for health authorities to look into with wide open eyes when they are
strengthening the health regulations by amending the cosmetic Devices
and Drugs Act 27 of 1980 imposing severe punishments of Rs. 100,000 or
one year jail sentence or both for violators of health regulations.
What Sri Lanka needs is a strict Pharmacovigilance system similar to
that of in the European Union. Why is such a system very vital? The
answer would be to monitor the safety of medicines and taking action to
reduce the risks and increase the benefits of medicines.
Our society is changing and the expectations of our citizens are also
changing. There is a need to ensure that we too have a system which is
robust but also transparent and effective.